Strengthening routine care during labour and childbirth can reduce early deaths and serious complications among newborns in sub-Saharan Africa, says a study in Nature Medicine
The study evaluated an intervention known as Action Leveraging Evidence to reduce perinatal Mortality and Morbidity (ALERT) in 16 hospitals across Uganda, Tanzania, Malawi and Benin. The programme combined health-worker training, quality improvement, leadership mentoring and the involvement of women, families and maternity staff in designing solutions to challenges within hospitals.
The researchers followed 134,630 women and 139,300 newborns during the study. Overall, ALERT was associated with a 22% reduction in the odds of early perinatal mortality, defined as fresh stillbirth or death of a newborn within 24 hours of birth.
The intervention was also associated with a 19% reduction in the odds of hypoxic–ischemic events, which are linked to oxygen deprivation in newborns. However, the study did not find a statistically significant reduction in fresh stillbirths.
The ALERT programme focused on six areas of maternity care: admission procedures, monitoring during labour, emergency preparedness, respectful care, labour and birth positioning, and communication and teamwork. Health workers received three-day competency-based training, while hospitals were supported through quality-improvement activities, mentoring and continuous monitoring of data.
“Our reduction in perinatal mortality and morbidity was achieved without technological innovations,” the researchers wrote.
One notable improvement was fetal monitoring. Checking the fetal heart rate when women were admitted increased from 89% to 95%, while documentation of continued fetal monitoring during labour also improved.
In Uganda, the results varied between hospitals. The researchers reported that one Ugandan hospital recorded a strong decline in early perinatal mortality, two recorded smaller improvements, while another remained largely unchanged.
The study also found a 14% increase in the odds of Caesarean section. Researchers said the increase was likely linked to earlier recognition of complications and more timely escalation of care, rather than harmful overuse.
However, the intervention did not significantly improve women’s reported experience of respectful care or responsiveness. The researchers suggested that changes in interpersonal behaviour may require more time and that structural and policy limitations may have affected the results.
The study’s findings point to the importance of combining different approaches rather than relying on training alone.
“Together, these findings reinforce the importance of multi-component strategies that address skills, systems and leadership simultaneously,” the researchers concluded.
The researchers say the findings demonstrate the potential of strengthening routine intrapartum care to improve newborn outcomes, particularly in health facilities where resources are limited.
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